Nutrition Care Process Quality Evaluation and Standardization Tool: The Next Frontier in Quality Evaluation of Documentation

Published:August 02, 2021DOI:


      Documentation is essential for communicating care between credentialed nutrition and dietetics practitioners and other health care providers. A validated tool that can evaluate quality documentation of the Nutrition Care Process (NCP) encounter, including progress on outcomes is lacking. The aim of the NCP Quality Evaluation and Standardization Tool (QUEST) validation study is to revise an existing NCP audit tool and evaluate it when used within US Veterans Affairs in all clinical care settings. Six registered dietitian nutritionists revised an existing NCP audit tool. The revised tool (NCP-QUEST) was analyzed for clarity, relevance, and reliability. Eighty-five documentation notes (44 initial, 41 reassessment) were received from eight volunteer Veterans Affairs sites. Five of six registered dietitian nutritionists participated in the interrater reliability testing blinded to each other's ratings; and two registered dietitian nutritionists participated in intrarater reliability reviewing the same notes 6 weeks later blinded to the original ratings. Results showed moderate levels of agreement in interrater reliability (Krippendorff’s α = .62 for all items, .66 for total score, and .52 for quality category rating). Intrarater reliability was excellent for all items (α = .86 to .87 for all items; .91 to .94 for total score and.74 to .89 for quality category rating). The NCP-QUEST has high content validity (Content Validity Index = 0.78 for item level, and 0.9 for scale level) after two cycles of content validity review. The tool can facilitate critical thinking, improved linking of NCP chains, and is a necessary foundation for quality data collection and outcomes management. The NCP-QUEST tool can improve accuracy and confidence in charting.
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      S. Lewis is director of the Anne Brezina Dietetics Internship Program, James A. Haley VA Hospital, Tampa, FL.


      L. Miranda is a certified diabetes care and education specialist and advanced practice nutrition consultant, VA San Diego Healthcare System, San Diego, CA.


      J. Kurtz is a certified diabetes educator and chief, nutrition, hospitality, & food service, Phoenix VA Health Care System, Phoenix, AZ.


      Linda Larison is a retired dietitian, Cincinnati VA Medical Center, Cincinnati, OH.


      W. J. Brewer is chair, Nutrition and Food Advisory Board (VHA Central Office), and chief, nutrition and food service, Aleda E. Lutz VAMC, Saginaw, MI.


      C. Papoutsakis is senior director, data science center, research, international and scientific affairs, Academy of Nutrition and Dietetics, Chicago, IL.